In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I created The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

By Scott Adams

Published on 07/26/1996

CEL-PRO
on Oats
The following
is an edited version of some of the opinions of the CEL-PRO, w

CEL-PRO
on Oats

The following
is an edited version of some of the opinions of the CEL-PRO, which
is a group of doctors who regularly discuss issues concerning celiac
disease. Disclaimer - this is NOT medical advise, it is a general
discussion of the oats issue. See your own doctor for application
to your particular situation.

Doctor
#1:

I will start off
the oats discussion by commenting that this is probably the single
most comprehensive study of the effects of a grain on celiacs. The
earlier evidence for oats as a deleterious agent in celiac disease
was based on a very small number of patients or case studies. Reading
the report in the NEJM this week would suggest that oats are safe
for most uncomplicated celiacs. There are however some reservations
about the study. Severe celiac disease was an exclusion, there were
some drop outs in both the oats and the control groups and patients
with complications were excluded. If the findings are general to the whole population of celiacs then it would certainly make life
a lot easier.

I have a concern
about whether oat flour is reliably free of contamination with barley/
wheat. Also what would happen if we challenged a celiac with high
doses of oat flour, greater than the 50g used in this study. Also
would oat flour protein produce any of the subtle changes seen in
the rectum with enema challenge.

Doctor
#2:

Here in Finland
[where the NEJM study was done] there are mixed feelings about oats.
Our colleagues from Kuopio have done a very good study, and in fact
the study is on-going. Five year follow-up results will tell us more,
the authors are this autumn re-biopsing the coeliacs eating oats.
Within our Celiac Disease Study Group we have discussed this, and
we are going to discuss the item within the expert team of the Finnish
Coeliac Society. At this point I want to say some words regarding
children.

Today we are not
going to allow coeliac children to eat oats. We are first going to
perform a study, our ethical committee has accepted our protocol.
We are also going to look at minor jejunal changes in the normal
mucosa revealed by immunohistochemistry. Again, the oats producer
will provide us the oats for the study (same deep-frozen tested batch
through the whole study). If no harm is seen, oats will be accepted
also for children and this is important in our country, we by tradition
consume oats. Then another story is whether all oat flour products
at our market are clean. This is a real practical problem and we will
study this. As you probably know, in Ireland the oats was contaminated,
Dr. Conleth Feighery and colleagues used in their study oats from
a German producer, tested not to be wheat contaminated (from the fields
and mills). The Irish study pointed at the same direction as the Finnish
one (9 adult coeliacs challenged with 50 g of oats for 3 months),
oats was tolerated. The authors also looked for immunological activation
in the mucosa, no changes were seen (paper presented at the 8th International
Congress of Mucosal Immunology, San Diego, July 1995, abstract Srinivasan
et al. Oats cereal is not immunogenic in coeliac disease. Clin Immunol
Immunopathol 1995;76 (part 2):S72).

Doctor
#3:

The results of
Kuopio group published in NEJM are probably changing our dietary recommendations.
[The author of #1] has recently discussed the situation in children.
The study has been carried out in adults, and in adults the demand
to change dietary recommendations is strong, as we have noticed during
the last days.

I think adult
celiac patients can switch to oats containing diet under strict follow-up.
The amount of oats tolerated, the long-term effect of oats, and the
importance of gliadin contamination has to be investigated, however.

I recommend to
my celiac disease patients that they should undergo gastroscopic examination 1-2
years after starting oats-containing diet. Some antecedent information
of the mucosal architecture should be available as well. If not, a
duodenal biopsy should be taken even before starting of oats. By this
way we also can observe possible minor inflammatory changes such as
an increase in IEL or alpha-beta T-cell receptor bearing lymphocytes.

If this arrangement
sounds too laborious, at least a strict follow-up by physicians and
dietitians are essential. The follow-up comprises general well-being,
signs of malabsorption and EmA or AGA analysis.